Provider Demographics
NPI:1225576663
Name:MCMILLAN, COFFEY
Entity Type:Individual
Prefix:
First Name:COFFEY
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N CENTRAL AVE
Mailing Address - Street 2:APT. 8A
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2502
Mailing Address - Country:US
Mailing Address - Phone:347-743-4003
Mailing Address - Fax:
Practice Address - Street 1:315 N CENTRAL AVE
Practice Address - Street 2:APT. 8A
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2502
Practice Address - Country:US
Practice Address - Phone:347-743-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486659111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist